First-time mothers’ experiences of early labour in Italian maternity care services

Abstract

Objective. To explore first-time mothers' experiences of early labour within Italian maternity care services in the event that women are admitted to hospital or advised to return home after maternity triage assessment. Setting. One second-level Maternity Hospital in northern Italy with an obstetric unit for both low and high-risk women. Participants. Fifteen first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy that accessed the maternity triage during the latent phase of labour, and were either admitted at the hospital or advised to return home. Design. Qualitative interpretive phenomenological study. One face-to-face recorded semistructured interview was conducted with each participant 48-72 hours after birth. Findings. Four key themes emerged from the interviews: a) recognising early labour signs; b) coping with pain at home; c) seeking reassurance from healthcare professionals; d) being admitted to hospital versus returning home. Uncertainty about the labour progress and the need for reassurance was referred by women as the main reasons for going to hospital in early labour. An ambivalent feeling was reported by the participants when being admitted to hospital in early labour. In fact, while in the first instance the women felt reassured, some felt dissatisfied later on due to the absence of one-to-one dedicated care during the latent phase of labour. When advised to go back home, a number of women manifested feelings of disappointment, anger, fear, discouragement and anxiety for not having been admitted to hospital; however, some participants reported a subsequent feeling of comfort with being at their own home and putting in place the suggestions provided by the midwives at the moment of maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women's satisfaction when advised either to return home or to stay at the hospital during the latent phase of labour. Conclusions and implications for practice. During antenatal classes and clinics, midwives should provide clear information and advice on early labour to increase women's confidence, self-efficacy and decrease their anxiety and fear. During early labour, appropriate maternity care services should be offered according to individual needs. When home visits are not provided by midwives, a telephone triage run by midwives should be considered as a routine service for the first point of contact with women during the latent phase of labour.

Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population

“…The present study found that women with a prolonged latent phase regardless of parity are dominating the group of women being admitted at earlier stages of cervical dilatation. According to the findings from Ängeby et al and Cappelleti et al, women with a prolonged latent phase wanted individually adapted care but not necessarily admittance to the labor ward. In Sweden, as in many other countries, women have no options for a home visit from a midwife during the latent phase.…”

“…Marowitz suggested that midwives can provide a significant amount of individually adapted care and support in early labor in order to delay admission, but a tension exits between delaying admission and women's difficulty in handling early labor at home. Previous studies show that individual midwifery support for women during latent phase is important. Paul et al's suggestion of an early labor lounge to engage women in labor‐promoting activities as a potential approach in lowering the cesarean birth rate in nulliparous women may be a promising strategy.…”

Experiences of early labour management from perspectives of women, labour companions and health professionals: A systematic review of qualitative evidence

“…A recent study by Cappelletti et al (2016) reported on the increasing role of technology on early labour management and experiences of women giving birth for the first time, with a range of apps now available to enable women to count the frequency and duration of their contractions. Other devices, including wearable abdominal monitors are also now being advertised which purport to enable women to distinguish between a contraction and abdominal cramps.…”

Timing of hospital admission in labour: latent versus active phase, mode of birth and intrapartum interventions. A correlational study

“…Despite agreement from maternity care providers, research evidence and international guidelines (1)(9) on the benefits of delaying hospitalization during the latent phase, childbearing women often manifest the need for reassurance and support during early labour and may expect to be admitted to hospital, even if not in active labour (19) (20) (21). Therefore, the latent phase of labour is recognized as an area of conflict between women and healthcare professionals (22).…”